The Menstrual Cycle with PMDs
The menstrual cycle is much more than “just a period.” It’s a complex, hormone-driven process that plays a central role in the female reproductive system. Each month, the body moves through a carefully coordinated sequence of changes, led by the sex hormones estrogen and progesterone, that prepares for the possibility of pregnancy.
A typical cycle lasts anywhere from 20 to 40 days, with the average around 28 days, though everybody is different. Factors like stress, genetics, and underlying health conditions can all influence the cycle's length and intensity.
Throughout this monthly rhythm, hormonal fluctuations don’t just impact the body—they can also affect mood, energy, focus, and emotional regulation. For many, this means occasional cramps, fatigue, or irritability. But for those with Premenstrual Disorders (PMDs) such as Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Exacerbation (PME), the impact is far more serious.
In the luteal phase, otherwise known as the premenstrual cycle, the second half of the cycle, some individuals experience intense psychiatric and physical symptoms that can upend daily life. These may include severe depression, rage, anxiety, suicidal thoughts, or intrusive symptoms of other chronic conditions. These reactions are not simply PMS—they stem from a neurological sensitivity to hormone changes that is real, measurable, and often misunderstood.
Understanding the menstrual cycle is a powerful first step toward validating these experiences and providing proper care. Below is a breakdown of the cycle’s phases—and how they may uniquely affect those living with PMDD or PME.
Menstrual Phase (Day 1–5)
Menstruation (your period) begins.
🩸 The endometrium, your uterine lining, sheds, leading to menstrual bleeding.
⚪️ ⬇️ Estrogen levels are at their lowest.
⚫ ⬇️ Progesterone levels are at their lowest.
PMDD
→ This phase often brings relief.
→ Symptoms may lift quickly (hours) or gradually (days) after menstruation begins, and this “symptom-free window” can feel like returning to yourself until your next ovulation, when your hormone levels rise again.
→ Some may feel physically drained or emotionally raw from the previous luteal (premenstrual) phase.
PME
→ Some people feel relief during this time, while others may still experience symptoms related to their underlying condition (e.g., fatigue, pain, low mood).
→ Symptoms usually return to baseline levels during this phase. But unlike PMDD, they don’t vanish completely.
Follicular Phase (Day 1–13)
Recovery, energy, and hope.
🩸 Overlaps with the menstrual phase at first.
⏳ Typically, the most extended phase of your menstrual cycle.
🧠 The brain signals the ovaries to develop follicles, each containing an egg.
🧱 The body begins building a new endometrium, the uterine lining.
⚪️ ↗️ Estrogen levels gradually rise, supporting improved mood, focus, and motivation.
PMDD
→ Hormone levels remain generally low and steady during the follicular phase, so no PMDD symptoms are present.
→ Many report this phase as their best time of the month, often called the “good weeks.”
→ It’s when they may feel most like themselves: productive, social, and emotionally stable.
→ However, some remain anxious about what’s to come, known as anticipatory anxiety.
PME
→ This can be a “better” phase.
→ People with PME may experience more manageable symptoms or even brief periods of improvement.
→ However, underlying conditions (like anxiety or depression) don’t disappear and will remain at their “usual” level.
Ovulation (Around Day 14)
Hormonal peak and change.
🟡 A spike in luteinizing hormone (LH) triggers the release of an egg.
⚪️ ⬆️ ➡️ ⬇️ Estrogen peaks, then drops suddenly after ovulation.
⚫ ↗️ Progesterone begins to rise.
🌱 This is the most fertile time of the cycle.
💥 Some people feel a slight twinge or cramping called mittelschmerz. Mittelschmerz, which translates to "middle pain" in German, refers to pain experienced during ovulation, a normal part of the menstrual cycle.
PMDD
→ This hormonal shift can be a turning point.
→ Some may notice subtle mood changes, physical symptoms, irritability, or fatigue soon after ovulation.
→ This is when PMDD symptoms often begin to emerge.
PME
→ This hormonal shift can be a turning point.
→ Some may notice subtle mood changes, physical symptoms, irritability, or fatigue soon after ovulation.
→ This is when PME symptoms often begin to emerge.
Luteal (Premenstrual) Phase (Day 15–28)
⛈️ The storm of PMDD.
⚪️ ⬇️ Estrogen drops and stays low.
⚫️ ↗️ Progesterone rises, peaks, and dominates to prepare the uterus for a possible pregnancy.
⚪️ ⬇️ ⚫️ ⬇️ If pregnancy doesn’t occur, both estrogen and progesterone levels drop sharply at the end of this phase before your period starts. (~Day 26-28)
PMDD
→ This phase is when symptoms "turn on” and peak, including rage, despair, anxiety, fatigue, and intrusive thoughts.
→ This phase is when the large hormone fluctuations cause the brain to react with negative emotional (and sometimes physical)symptoms.
→ Many struggle with relationships, work, and daily functioning.
→ For some, this time can bring suicidal thoughts or self-harming urges.
→ Symptoms typically begin to lift after bleeding starts.
→ Everyone is different, and while some may experience symptoms throughout the luteal phase, others may experience them for a shorter timeframe.
→ Heightened physical body sensitivity, including normal hormone fluctuations, may make otherwise minor sensations feel sharper or more painful.
PME
→ This is when symptoms worsen most significantly.
→ The underlying condition flares, often causing:
→ Increased depression, anxiety, irritability, or intrusive thoughts
→ Trouble concentrating or sleeping
→ Stronger physical pain, fatigue, or sensory issues
→ Emotional dysregulation or hopelessness
Then the cycle repeats.
Why Tracking Matters
Premenstrual Disorders (PMDs) cannot be diagnosed through blood, hormone, or saliva tests. While these tests can help rule out other underlying conditions, such as hormone imbalances or thyroid disorders, they cannot confirm a diagnosis. The only current method for diagnosing PMDD is by tracking symptoms daily throughout at least two menstrual cycles.
Because PMDD and PME symptoms are cyclical, it is crucial to understand your patterns, especially regarding ovulation and the luteal phase. Tools like the IAPMD PMDs Symptom Tracker. This downloadable tracker includes the Daily Record of Severity of Problems (DRSP), the gold-standard, clinically validated tool used by healthcare providers, clinicians, and researchers to help you see your cycle clearly and advocate for appropriate care.
Please print out these tracking sheets and complete them daily to capture how symptoms change throughout your cycle for at least two full menstrual cycles. Bring the completed charts to healthcare appointments to support evaluation, diagnosis, and treatment planning.